So many people are dying from drugs and alcohol in the Twin Cities metro that busy medical examiners are now skipping some routine autopsies of older adults who died of natural causes.

It's another example of the grim impact of the worsening overdose crisis in Minnesota and across the nation. In 2022, nearly 110,000 people in the U.S. died from overdoses, including 1,343 Minnesotans.

In the Twin Cities, drug and alcohol deaths have jumped more than 100% since 2019. Last year, 41% of the postmortem exams done in Hennepin County and half of those done in Ramsey County involved people who died from drugs and alcohol.

Determining how those people died takes time — and it means the Hennepin County medical examiner no longer has time to perform autopsies on people older than age 55 who are believed to have died from natural causes, which had been common practice in the past. Ramsey County lowered the threshold to age 60.

"There's a finite number of cases we can do every year. If more and more of those are taken up by drugs and alcohol, something has to give somewhere," said Hennepin County Medical Examiner Andrew Baker.

"Most people think you can stick a needle in a dead body, suck out some blood and send it to a lab," Baker said. "You only know a death is a drug toxicity after you have done a complete autopsy."

His office investigates all unexpected deaths in Hennepin County, as well as in Scott and Dakota counties. The Ramsey County office also investigates deaths in Washington County and 16 rural counties.

Why the change?

It's not just drug and alcohol deaths that spiked since the pandemic. Homicides and motor vehicle fatalities also increased, so to keep up with the growing workload, medical examiners had to adjust.

Previously, men younger than 60 and women under 65 had postmortem exams in Hennepin County, even when their deaths were believed to be from natural causes. Those procedures are not required by any state or national standard, but they help families and public health officials better understand why people die prematurely.

Now, the age cutoff is lower. Hennepin and Ramsey counties generally won't autopsy people in their mid- to late 50s or 60s who apparently die of natural causes. After reviewing years of data, Baker said, he is not worried that the change will lead to missing any suspicious deaths.

"Every homicide was so self-evident from the scene or something was so clearly awry that you would have done that autopsy," Baker said.

What substances are to blame?

In 2022, Hennepin and Ramsey counties recorded 57% of the state's overdose deaths and 35% of alcohol deaths, according to the Minnesota Department of Health.

Of the 1,343 Minnesotans who died last year of overdoses, 1,002 involved opioids. Fentanyl was involved in 92% of the state's opioid-related fatalities.

The Health Department said in October that last year's statewide overdose deaths fell slightly from the year before. But that's not the case in the Twin Cities, where drug deaths continued their dramatic climb in both metro counties.

Alcohol abuse is also a growing problem. Drinking too much takes longer to have serious health effects, but the results can be just as deadly as harder drugs.

Fatalities attributed entirely to alcoholism increased by 37% statewide since the pandemic, with 1,123 deaths reported in 2022. Hennepin and Ramsey counties also saw increases in alcohol-related deaths during that time.

No end in sight

The overdose crisis is showing no signs of slowing down.

Provisional data from the federal Centers for Disease Control and Prevention show Minnesota overdoses up about 4.5% through last May. Nationally, they rose 2.5%.

Dr. Eric Dawson, vice president of clinical affairs at Millennium Health, said Minnesota also exceeds the national average for positive fentanyl and methamphetamine tests.

Millennium processes about 50,000 urine samples each year from Minnesota treatment providers who screen patients struggling with substance abuse. The results act as a predictor of which drugs are popular and could kill.

Millennium warned Thursday that two powerful veterinary tranquilizers — carfentanyl and xylazine — were turning up in drug tests, including in Minnesota.

Carfentanyl is 100 times more powerful than fentanyl. Xylazine, also called "tranq," is a dangerous sedative the U.S. Drug Enforcement Administration called the "deadliest drug threat our country has ever faced."

Dawson warned that much of the nation's street drug supply contains fentanyl and other cheap and deadly narcotics. He said opioid overdose reversal drugs such as naloxone — commonly called Narcan — are the best option to keep drug users out of the morgue.

"Anyone who is determined to use drugs should keep Narcan in their hand," Dawson said. "It needs to be immediately accessible."